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Area of Science:

  • Gastroenterology
  • Endoscopic Surgery
  • Oncology

Background:

  • Colorectal endoscopic submucosal dissection (CR-ESD) is technically challenging, limiting its widespread adoption.
  • Technical difficulty is defined by prolonged procedure duration (≥150 min), perforation, or piecemeal resection.

Purpose of the Study:

  • To identify risk factors associated with technical difficulty during CR-ESD.
  • To analyze how endoscopist experience influences these risk factors over time.

Main Methods:

  • A prospective cohort study analyzed 247 colorectal tumors treated with ESD between 2006 and 2010.
  • Tumor location, type, and colonoscopy-related factors were investigated.
  • Logistic regression and subgroup analyses were performed for earlier and later treatment periods.

Main Results:

  • Flexure location was a significant risk factor for longer procedure duration, piecemeal resection, and perforation.
  • Tumors with scarring or local recurrence increased procedure duration and piecemeal resection rates.
  • Large tumors (≥50 mm) or those spreading across folds were the strongest predictors of prolonged duration, especially in the later period.

Conclusions:

  • Key factors predicting CR-ESD technical difficulty were identified, including tumor characteristics and location.
  • The impact of these risk factors on CR-ESD outcomes is influenced by the endoscopist's accumulating experience.